Can I receive the Penbraya meningococcal vaccine while taking Rinvoq (upadacitinib)?

Can You Receive Penbraya Vaccine While Taking Rinvoq?

Yes, you can receive the Penbraya (MenACWY-TT/MenB-FHbp) meningococcal vaccine while taking Rinvoq (upadacitinib), and in fact, vaccination should be prioritized before starting or while on this immunosuppressive therapy.

Key Vaccination Principles for Patients on JAK Inhibitors

Patients on immunosuppressive medications like Rinvoq should receive indicated vaccines to reduce infection risk, though immune response may be somewhat reduced. 1

When to Vaccinate

• Ideally, complete meningococcal vaccination at least 2 weeks before starting Rinvoq to optimize immune response. 2
• If already on Rinvoq, vaccination should still proceed as the potential benefit outweighs risks, even with possible reduced immunogenicity. 3
• Do not delay necessary vaccination waiting for an "optimal" window—protection is better than no protection. 2

Who Should Receive Penbraya on Rinvoq

Standard Risk Patients (Ages 16-23 Years)

• Penbraya may be used when both MenACWY and MenB vaccines are indicated at the same visit, based on shared clinical decision-making. 1
• This applies to healthy adolescents and young adults aged 16-23 years (preferred age 16-18 years) when MenB vaccination is favored after discussing individual risk factors. 1
• The decision should consider college attendance, dormitory living, or participation in fraternities/sororities, which increase meningococcal disease risk. 2

High-Risk Patients (Ages ≥10 Years)

Patients on Rinvoq who have additional high-risk conditions absolutely require meningococcal vaccination with Penbraya. 1 High-risk conditions include:

• Complement deficiencies (inherited or acquired) 4
• Complement inhibitor use (e.g., eculizumab) 4
• Anatomic or functional asplenia 4
• HIV infection 3
• Microbiologists routinely exposed to N. meningitidis 4

Important caveat: JAK inhibitor use alone (like Rinvoq) does NOT automatically classify patients as high-risk requiring enhanced meningococcal vaccination protocols. 3 Enhanced protocols are only needed when additional high-risk conditions coexist. 3

Dosing Schedule for Penbraya

• Penbraya is administered as a 2-dose series. 1
• The second dose should be given at least 6 months after the first dose (following the MenB-FHbp component schedule). 2
• Critical: All subsequent MenB-containing doses must be from Pfizer (either Penbraya or Trumenba), as different manufacturers' serogroup B vaccines are NOT interchangeable. 1

Booster Dose Recommendations

For High-Risk Patients on Rinvoq

• MenACWY boosters every 5 years 3
• MenB boosters: First booster at 1 year after primary series completion, then every 2-3 years thereafter 4

For Standard Risk Patients

• MenACWY booster at age 16 years if initial dose given at age 11-12 years 5
• MenB boosters generally not recommended for those without ongoing increased risk 4

Administration Guidelines

• Penbraya can be given simultaneously with other indicated vaccines but must be administered at a different anatomic site (e.g., opposite arm). 5
• Do not mix vaccines in the same syringe. 5
• Document each vaccine in the patient's permanent medical record. 5

Safety Considerations

• No specific contraindications exist for giving Penbraya to patients on Rinvoq. 1
• The main concern is potentially reduced vaccine efficacy due to immunosuppression, not increased adverse events. 3
• Severe allergic reaction to a previous meningococcal vaccine dose or any vaccine component is a contraindication. 2
• Monitor for 15 minutes post-vaccination to manage potential syncope, especially in adolescents. 2

Common Pitfalls to Avoid

• Do not defer vaccination indefinitely waiting for Rinvoq to be discontinued—the infection risk while unvaccinated outweighs concerns about reduced vaccine response. 2
• Do not switch between MenB vaccine manufacturers mid-series—this results in inadequate protection and requires series restart. 2, 1
• Do not assume JAK inhibitor use alone qualifies for high-risk vaccination protocols—verify presence of additional risk factors. 3
• Do not forget booster doses in high-risk patients—immunity wanes within 1-2 years for MenB vaccines. 2, 4